Артериальная гипертензия, по определению экспертов Всемирной организации здравоохранения (ВОЗ) и Международного общества по гипертензии (МОГ) — «WHO‑ISH guidelines for the management of hypertension» (1993, 1996), — это повышение артериального давления (систолическое 140 мм рт. ст. и/или диастолическое 90 мм рт. ст.), зарегистрированное не менее чем при двух врачебных осмотрах, при каждом из которых оно измеряется, по крайней мере, дважды.
По новому определению ВОЗ‑МОГ (1999), под артериальной гипертензией понимают уровень систолического артериального давления, равный 140 мм рт. ст. или более, и (или) уровень диастолического артериального давления, равный 90 мм рт. ст. или более, у людей, которые не получают антигипертензивных препаратов. Учитывая значительные спонтанные колебания артериального давления, диагноз артериальной гипертензии должен основываться на результатах его многократного измерения при повторных посещениях врача..
Артериальная гипертензия (артериальная гипертония), будучи групповым понятием, включает в себя эссенциальную гипертензию (гипертоническую болезнь, синонимы — гипертензивная болезнь, эссенциальная артериальная гипертония, первичная артериальная гипертония) и разнообразные вторичные (симптоматические) артериальные гипертензии. Около 5% артериальных гипертоний являются вторичными или симптоматическими — то есть вызванными определенными причинами (заболеваниями).
Артериальные гипертензии классифицируют по целому ряду критериев.
По механизмам развития выделяют первичную (гипертоническая болезнь) и вторичную (симптоматическая) гипертензию. Последняя, в свою очередь, делится на почечную (реноваскулярную и ренопривную), эндокринную (при кушингоидном синдроме, болезни Конна, феохромоцитоме, гипертиреозе), центрогенную (органические повреждения структур головного мозга, регулирующих артериальное давление) и рефлексогенную (повреждение барорецепторных зон).
По изменению общего сосудистого сопротивления выделяют гипер-, нормо- и гипорениновую гипертензию; по изменению ударного объема сердца — гипер-, нормо- и гипокинетическую; по виду увеличения артериального давления — систолическкую, диастолическую и систоло-диастолическую, по течению — быстропрогрессирующую (злокачественную), доброкачественную, медленнопрогрессирующую, непрогрессирующую. Используют также классификации по уровню повышения давления, наличию или отсутствию функциональных осложнений (хроническая почечная недостаточность, сердечная недостаточность, ухудшение зрения, инсульт), гипертонических кризов и т.д.
Гипертоническая болезнь (эссенциальная гипертензия) — это хроническое заболевание, основным проявлением которого служит повышение артериального давления. К основным факторам риска развития гипертонической болезни относят наследственность, психо-эмоциональное перенапряжение и избыточное потребление поваренной соли, а также курение, злоупотребление алкоголем, повышенную массу тела, сахарный диабет, гиподинамию и др.
Основные теории патогенеза гипертонической болезни.
1. Теория Г.Ф. Ланга и А.Л. Мясникова — инициальный фактор патогенеза — психо-эмоциональное перенапряжение со снижением тормозящего влияния коры головного мозга, оказываемого ею в норме на подкорковые вегетативные центры, прежде всего вазопрессорные, что вызывает их стойкое перевозбуждение.
2. Теория А. Guyton и соавт. — инициальный фактор патогенеза — генетически обусловленный дефект почечно-объемного механизма регуляции артериального давления, заключающийся в снижении способности почки выводить Na и воду в ответ на неизбежные эпизоды повышения артериального давления, обусловленные различными причинами. Пусковой механизм — повышенное потребление поваренной соли.
3. Мембранная теория Ю.В. Постнова и С.Н. Орлова — инициальный фактор патогенеза — генерализованный наследственный дефект мембранных ионных насосов клеток, включая гладкомышечные клетки артериол, что приводит к избытку ионов Ca и Na в цитоплазме гладкомышечных клеток и вызывает их спазм, а также повышение чувствительности к прессорным факторам..
В значительной мере все эти факторы приводят к увеличению артериального давления вследствие спазма артериол и мелких артерий, повышения периферического сосудистого сопротивления, обусловленного активацией, прежде всего, ренин-ангиотензиновой системы, а также повышением минутного объема сердца (гиперволемией).
На основании морфо-функциональных изменений выделяют 3 стадии гипертонической болезни (А.Л. Мясников): транзиторную; распространенных сосудистых изменений; вторичных органных изменений. По преимущественной локализации поражений органов (органов-мишеней) выделяют сердечную, мозговую и почечную клинико-морфологические формы, а по течению – доброкачественный и злокачественный варианты заболевания. Злокачественная гипертензия характеризуется нефросклерозом Фара (фибриноидный некроз артериол почки, капиллярных петель клубочков, отек, геморрагии с развитием быстроразвивающейся почечной недостаточности), а также поражением сетчатки глаза с кровоизлияниями и двусторонним отеком диска зрительного нерва. Она развивается преимущественно у мужчин в возрасте 35-50 лет, иногда до 30 лет, быстро прогрессирует, приводя к летальному исходу при отсутствии адекватной терапии через 1-2 года. В настоящее время встречается редко.
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sanitary valves and vigorous electric motor, with a focal point on its sustainability. The aftermarket tuning specialists at RST have built an incredibly sanitary valvespowerful Porsche 911 GT2 RS. The fastest factory Porsche available was given a full performance makeover to push it past the 1,000-horsepower threshold. Buying a vehicle is often the second biggest investment in a person's life. To ensure you're making the best decision at selecting the right vehicle, it is imperative the check a vehicle's history before making a purchase. A car's value is largely determined by its paint, and candle holders wholesale a superb gloss will always pay back. During washing, areas of high dirt accumulation such as behind the wheel wells should be washed last as debris will contaminate the water and the wash mitt therefore creating scratches in the paint. Another essential maintenance tip though given little thought is the washing material and type of soap and polish used. Use of abrasive substances will strip some paint off and wear away the protection which diminishes the shine and fosters the aging effects. To best Copper Doorsmaintain your paint, waxing is better than polishing as it does not remove any surfaces caused by abrasion. Always remember that a car's looks will always reflect the owner, and a little shine goes a long way. In this following article you will find some useful tips on what you can do to prepare your car before you go on a road trip with it. Going on a road trip is obviously a lot of fun, but there are some preparations you need to make regarding your car before you even leave your driveway. Walnut shell blasting for vehicles is demystified in this article. How does it work? What does it do? Both of these questionsGravure printing machine and more are answered. When it comes to choosing your car's paint, the choice goes well beyond your favourite. It is about what is best for your car at that time and place and the same time offering the appeal you wish to accord and your own self satisfaction. This therefore translates to considering your climate, your vehicle's design and for what purposes the vehicle will serve, maybe even for how long you wish to have it. A car's paint could be the difference between buying and not buying the car, and it also reflects the owner to some extent. Some will easily hide dirt while others will hardly be visible at night, so when you next wish Portable x-ray equipmentto repaint your vehicle ensure you make the right choice. How a van void of vehicle graphics could be costing your business potential customers. We offer advice on finding the right choice for your company and budget. During the winter months your car has to endure some harsh environmental factors. Everything can be affected here from your plastic trims to your paintwork and wheels so it's well worth getting powder sieving machineprepared now before the harsh weather comes. Resin Transfer (RTM) is an efficient method of producing composite products, suited to medium volume production projects. A resin is injected into a closed already containing a pre-formed reinforcement. The German super car tuning specialists at have developed and designed an all-new in-house supercharger upgrade program for the new Mercedes-Benz SLS AMG. Called the "Supercharged GT", the new program boost output past 700 horsepower and gives the SLS AMG a new, more sinister look. Find out what 7 inch tablet pcperformance upgrades and parts will help give you the performance power and handling to drive off-road.
Coating Machine These performance parts will reduce impact damage on your vehicle and give you the power needed to traverse uneven Coating Machinesurfaces. Off-road driving means crossing variable and unpredictable terrain and you want to make sure your vehicle has the performance power to handle any eventuality you might come across. Off-road driving will cause a significant amount of pressure on various parts of your vehicle and engine components, and upgrading your vehicle with the below performance parts can extend its life as well as help you avoid off-road risks. Custom exhaust upgrades High-performance exhaust systems enhance your engine's ability to expel the trapped gas from your engine and exhaust, leading tosantiary check valves improved fuel efficiency and... Car graphics can help you to promote your business on the road and potentially reach a larger audience. While most companies that offer vehicle graphics can install them for you, it is possible to apply them on your own. You just need to be sure that you are careful with the application and understand that a bad install may result in bubbling and damage to the graphics. An automobile is one of the largest investments that any individual ever makes in his lifetime. So keeping that investment as clean photo frames wholesale and well maintained as possible is important. Car washing is not like most other cleaning tasks. So, most of auto detailing agencies use car pressure washer i.e. differs from conventional pressure washing machines in many aspects. Some features of mobile car wash pressure washer machines are as follows: Indeed, I learned a long time ago that if you wish to run proficient and efficient detailing operations, that you need to stay organized. It doesn't matter if you are detailing boats, cars, trucks, motorcycles, or airplanes. You have to think in a Six Sigma Way. You have to think like a major corporation and consider abendkleiderfinite capacity scheduling models and assembly line production. You might think that's rather laughable and hilarious considering you are only doing the simplest job of cleaning something, whatever that object might be. If you are an auto detailer perhaps you've noted that it's taking you far too long to clean a vehicle and still charge a low enough price to stay ahead of the competition. When we are in a recessionary period there tends to be a lot of bottom feeders, or should Tablet PC manufacturerI say low-cost high-volume competitors out there. Often they will discount a detail to $100 or less, something that might take you to two-and-a-half to four hours to complete. I've always said; the money is in the time not the job, and you can increase the efficiency of your workflow, and if you can cut the time it takes to do a quality job by 30 minutes, you may actually be able to compete at a similar price point. A couple x-ray tubeof years ago, I talked to a gentleman at Starbucks who was on disability. He had worked for a carpet installation company and had blown out his knees, both of them and could hardly walk, and one could not be repaired, although they tried by putting in some titanium. He admitted it did help for a while, but his knee was simply to tore up inside. You see, those that install carpets often use their knees to help pound the nails in the baseboard during installations as he explained it to me. Interestingly enough, I understand how important it is to save your knees because Steel Doorspreviously I was a tack star and later had raced street motorcycles, and also had done quite a bit of auto detailing. In the summer .
I don't mind admitting I have antisocial tendencies. I don't think it's at all unusual in my age group (50+). I mean if we've lived a little then we've probably seen an awful lot, which means there's not a great deal left to tickle us with. You might bear that in mind when I tell you coach handbags outlet I tootled off to the West coach outlet End for the Vogue Fashion's Night Out last Thursday (September 6). It's an annual shopping event that takes place in various cities across the world, with the supposed intention of turning the shopping experience into something exciting. "Go and have a look," said the editor "and see what you think."
Like most fashion events FNO operates on two levels – the Fashion Insider and the Fashion Tourist. The Insider events are all 'invitation only' and you have to be on Someone Somewhere's list to get through the door. This avoids the necessity of joining the endless queues of Fashion Tourists snaking up and down and around and around Bond Street because if you're 'big' in fashion you have neither the time nor the inclination to stand about when you could be doing something that looks far more important. Courtesy of the Guardian I had two such invitations and here's what I did.
The W London is usually the last place you'd find me at 5pm on a weekday but they were holding private screenings of Breakfast at Tiffany's, Richard Press's excellent film on Bill Cunningham (New York Times photographer), and Ultrasuede: In search of Halston. I did my growing up in the 70s so of course I love Halston, and Studio 54, and decadence. I suffered a spot of confusion in W, mainly because I was in unfamiliar territory coach factory outlet online specifically designed to challenge short-sighted, middle-aged people with astigmatism: everything is mirrored and - double horrors - the loos are down a mirrored corridor too. Also the cocktail bar is way too high for vertically challenged individuals and the bar stools are impossible for the same reason. Once I'd navigated the hall of mirrors and got louis vuitton outlet online a glass of champagne safely in my hand (it's alright, the sun was over the yard arm somewhere in the world) I found I'd got a showing of the Halston film all to myself. A whole private cinema just for me! If I'm ever rich and famous this will be the way I watch ALL my films. www.louisvuittonpursebag.com It was, by the way, a strangely chaotic film which coach purses outlet narrowly missed nailing Halston's genius, but the grainy Studio 54 footage was a divine reminder of an insanely glamorous fashion era.
After that it was a quick scooch across to Chanel coach outlet store online on Bond Street for a presentation of five classic Chanel outfits from the current collection to celebrate the arrival of a new book, Vogue on… Coco Chanel by Bronwyn Cosgrave. Here's another confession – Chanel terrifies me. With its effortless chic and monumental price tags it's bloody intimidating, not to mention the formidable (if not actual) presence of Karl Lagerfeld, and that was without Gog and Magog on the door. Actually, it was the size of the two doormen that triggered another spot of confusion – I joined the queue. I had a coach outlet online nice Coach Factory Online chat with a young Polish designer (ex-Central St Martins), I watched the rich and famous come out of Tiffany next door, and I waited. The Polish coach outlet online designer was scouted and coach bags outlet photographed by a model agency and I waited. I watched possibly the worst attempt I've ever seen at a pick-up Louis Vuitton Purses and I waited. I was admiring the man-in-a-skirt when the nice Polish designer suggested I might be in the wrong queue seeing as I had an invitation and everything. He was right. I shuffled up to Gog and Magog, got whisked through, handed a peach Bellini and plonked on the second row in the salon upstairs, which is when I suddenly became acutely and uncomfortably aware that like any good Guardianista I was wearing Birkenstocks. Ah well – there was a lot of walking to do.
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